Daily Archives: December 4, 2019

(The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.)

Cason Schmit, Texas A&M University

(THE CONVERSATION) The nations second-largest health system, Ascension, has agreed to allow the software behemoth Google access to tens of millions of patient records. The partnership, called Project Nightingale, aims to improve how information is used for patient care. Specifically, Ascension and Google are trying to build tools, including artificial intelligence and machine learning, to make health records more useful, more accessible and more searchable for doctors.

Ascension did not announce the partnership: The Wall Street Journal first reported it.

Patients and doctors have raised privacy concerns about the plan. Lack of notice to doctors and consent from patients are the primary concerns.

As a public health lawyer, I study the legal and ethical basis for using data to promote public health. Information can be used to identify health threats, understand how diseases spread and decide how to spend resources. But its more complicated than that.

The law deals with what can be done with data; this piece focuses on ethics, which asks what should be done.

Beyond Hippocrates

Big-data projects like this one should always be ethically scrutinized. However, data ethics debates are often narrowly focused on consent issues.

In fact, ethical determinations require balancing different, and sometimes competing, ethical principles. Sometimes it might be ethical to collect and use highly sensitive information without getting an individuals consent.

Public health ethics are useful to evaluate activities that affect population health. A recent report by the World Health Organization (WHO) describes public health ethics with four principles:

- Common Good Does the activity promote collective benefit?

- Equity Does the activity reduce the burdens or risks to health or opportunity?

- Respect for Persons Does the activity support individual rights and interests?

- Good Governance Does the activity have processes for public transparency and accountability?

Public health ethics is an appropriate framework for evaluating Project Nightingale, given its massive scale. But the current health care context is relevant.

The system and its struggles

For over a decade, scholars have argued that technological solutions are needed to address three major challenges to how the health system uses information.

First, the health system struggles to integrate new knowledge into patient care. New medical evidence takes 17 years to change clinical practice, on average. The breakneck pace of science challenges doctors to keep up. And, applying modern medical knowledge requires doctors to consider more factors than is humanly possible.

Second, information is central to preventing many medical errors, the third leading cause of death in America. Communication problems, judgment errors and incorrect diagnosis or treatment decisions can have devastating consequences for patients.

Third, the system does not learn from care. For example, a doctor and patient might try several different medications before finding the right one. One medication might not help, another might cause awful side effects, and finding the best medication might take months or years. The health system does not learn from that care process. Individual providers will gain knowledge over a lifetime, but that knowledge is never aggregated or shared efficiently.

To help address these challenges, the Institute of Medicine in 2007 introduced a vision for a learning health system that would quickly learn from patient care and use that knowledge to improve future care.

The concept is simple, but learning health systems require sophisticated information technology platforms capable of extracting knowledge from the existing evidence and millions of treatment records.

The benefits of Project Nightingale

Project Nightingale appears to align with the learning health system concept. Systematically improving health care is a clear common good.

Although a learning health system requires sharing patient data, patients stand to benefit from improved health care. Reciprocal data sharing by patients for a collective benefit is a prototypical example of the common good principle in public health ethics.

Project Nightingale might also improve health equity. For example, minorities and pregnant women are underrepresented in research studies, raising concerns that some medical knowledge might not be well tailored to these patients. A learning health system would improve understanding of what treatments are effective and safe for these underrepresented populations.

For small-scale activities, respect for persons usually demands giving people an opportunity to make a free and informed decision to participate. However, for activities carried out at the scale of the whole population, it is possible to show respect for persons by engaging the public and inviting them into the decision-making process. It is not clear whether Ascension or Google involved the public or patients in Project Nightingale.

The downsides

Some patients have criticized Project Nightingale because it does not have an opt-out for patients who do not want their information shared.

However, opt-out systems raise ethical concerns, too. They permit free riders who will benefit from the knowledge gained from the participants. Second, knowledge from a learning health system could be biased if enough people opt out. If so, opting out could expose others to riskier health care.

Good governance is critical to support a common good activity that conflicts with some individual interests. Transparency and accountability are crucial to keep the parties honest and open to public scrutiny. They also empower people to demand government action against an activity that cannot be ethically justified. There is little, if any, reported evidence that Project Nightingale has sufficient transparency or accountability processes. This is likely to be the biggest ethical challenge to Project Nightingale.

Issues of consent

Some of the biggest concerns have been about consent. However, public health ethics do not always require consent. One recent WHO ethical guideline says:

Individuals have an obligation to contribute when reliable, valid, complete data sets are required and relevant protection is in place. Under these circumstances, informed consent is not ethically required.

The basic argument is that individuals have a moral obligation to contribute when there is low individual risk and high population benefit.

Currently, the public does not know enough about Project Nightingale to make definitive ethical judgments. However, public health ethics likely provides some support for what Google and Ascension are trying to do. The more critical ethical issue might turn on how Google and Ascension are doing it.

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This article is republished from The Conversation under a Creative Commons license. Read the original article here: http://theconversation.com/the-tricky-ethics-of-googles-project-nightingale-an-effort-to-learn-from-millions-of-health-records-127219.

See more here:

The tricky ethics of Google's Project Nightingale, an effort to learn from millions of health records - Jacksonville Journal-Courier

The nations second-largest health system, Ascension, has agreed to allow the software behemoth Google access to tens of millions of patient records. The partnership, called Project Nightingale, aims to improve how information is used for patient care. Specifically, Ascension and Google are trying to build tools, including artificial intelligence and machine learning, to make health records more useful, more accessible and more searchable for doctors.

Ascension did not announce the partnership: The Wall Street Journal first reported it.

Patients and doctors have raised privacy concerns about the plan. Lack of notice to doctors and consent from patients are the primary concerns.

As a public health lawyer, I study the legal and ethical basis for using data to promote public health. Information can be used to identify health threats, understand how diseases spread and decide how to spend resources. But its more complicated than that.

The law deals with what can be done with data; this piece focuses on ethics, which asks what should be done.

Beyond Hippocrates

Big-data projects like this one should always be ethically scrutinized. However, data ethics debates are often narrowly focused on consent issues.

In fact, ethical determinations require balancing different, and sometimes competing, ethical principles. Sometimes it might be ethical to collect and use highly sensitive information without getting an individuals consent.

Public health ethics are useful to evaluate activities that affect population health. A recent report by the World Health Organization (WHO) describes public health ethics with four principles:

Public health ethics is an appropriate framework for evaluating Project Nightingale, given its massive scale. But the current health care context is relevant.

The System and Its Struggles

For over a decade, scholars have argued that technological solutions are needed to address three major challenges to how the health system uses information.

First, the health system struggles to integrate new knowledge into patient care. New medical evidence takes 17 years to change clinical practice, on average. The breakneck pace of science challenges doctors to keep up. And, applying modern medical knowledge requires doctors to consider more factors than is humanly possible.

Second, information is central to preventing many medical errors, the third leading cause of death in America. Communication problems, judgment errors and incorrect diagnosis or treatment decisions can have devastating consequences for patients.

Third, the system does not learn from care. For example, a doctor and patient might try several different medications before finding the right one. One medication might not help, another might cause awful side effects, and finding the best medication might take months or years. The health system does not learn from that care process. Individual providers will gain knowledge over a lifetime, but that knowledge is never aggregated or shared efficiently.

To help address these challenges, the Institute of Medicine in 2007 introduced a vision for a learning health system that would quickly learn from patient care and use that knowledge to improve future care.

The concept is simple, but learning health systems require sophisticated information technology platforms capable of extracting knowledge from the existing evidence and millions of treatment records.

The Benefits of Project Nightingale

Project Nightingale appears to align with the learning health system concept. Systematically improving health care is a clear common good.

Although a learning health system requires sharing patient data, patients stand to benefit from improved health care. Reciprocal data sharing by patients for a collective benefit is a prototypical example of the common good principle in public health ethics.

Project Nightingale might also improve health equity. For example, minorities and pregnant women are underrepresented in research studies, raising concerns that some medical knowledge might not be well tailored to these patients. A learning health system would improve understanding of what treatments are effective and safe for these underrepresented populations.

For small-scale activities, respect for persons usually demands giving people an opportunity to make a free and informed decision to participate. However, for activities carried out at the scale of the whole population, it is possible to show respect for persons by engaging the public and inviting them into the decision-making process. It is not clear whether Ascension or Google involved the public or patients in Project Nightingale.

The Downsides

Some patients have criticized Project Nightingale because it does not have an opt-out for patients who do not want their information shared.

However, opt-out systems raise ethical concerns, too. They permit free riders who will benefit from the knowledge gained from the participants. Second, knowledge from a learning health system could be biased if enough people opt out. If so, opting out could expose others to riskier health care.

Good governance is critical to support a common good activity that conflicts with some individual interests. Transparency and accountability are crucial to keep the parties honest and open to public scrutiny. They also empower people to demand government action against an activity that cannot be ethically justified. There is little, if any, reported evidence that Project Nightingale has sufficient transparency or accountability processes. This is likely to be the biggest ethical challenge to Project Nightingale.

Issues of Consent

Some of the biggest concerns have been about consent. However, public health ethics do not always require consent. One recent WHO ethical guideline says:

Individuals have an obligation to contribute when reliable, valid, complete data sets are required and relevant protection is in place. Under these circumstances, informed consent is not ethically required.

The basic argument is that individuals have a moral obligation to contribute when there is low individual risk and high population benefit.

Currently, the public does not know enough about Project Nightingale to make definitive ethical judgments. However, public health ethics likely provides some support for what Google and Ascension are trying to do. The more critical ethical issue might turn on how Google and Ascension are doing it.

Cason Schmit is assistant professor of law at Texas A&M University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

See the rest here:

The Tricky Ethics of Google's Project Nightingale Effort to Learn from Millions of Health Records - Nextgov

DONALDSONVILLE The Ascension Parish School Board and the parish government are looking at jointly tackling carpool traffic problems at some of the older schools in the parish, with a new venture at one of those schools, Galvez Primary.

Under a proposed agreement, the School Board would provide the design and construction materials and the parish will provide the labor to extend the carpool line which is now simply one lane of two-lane Bayou Henderson Road in front of the school with a gravel drive onto unused property on the school site, to get more carpool traffic off the road.

"This is the first of what could be more, future agreements," Chad Lynch, the district's director of planning and construction, told the board's facilities management committee at its meeting Tuesday.

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The committee voted to recommend that the full board approve the Galvez Primary agreement at its next meeting.

Older schools don't have the turn lanes that the fast-growing school district incorporates at the entrances to the schools it has built since 2000, Lynch said.

Parish council members this past summer asked Lynch and his staff to meet with the council's transportation committee to start working out a solution for the carpool traffic problems.

PRAIRIEVILLE Daniel Johnson and his neighbors in Parker Place Estates face an either-or choice on school mornings, they say.

In addition to Galvez Primary, other schools facing those traffic woes include Prairieville Primary, Oak Grove and Central Primary.

The School Board will vote on the Galvez Primary proposal at its first meeting in the new year, on Jan. 7.

The board will also be voting at that meeting on the renewal of another intergovernmental agreement between the school district and the parish, an existing one set to expire on Dec. 31, that allows the parish to use four schools as shelters in time of emergency.

The four-year agreement allows the parish to use Dutchtown High and Dutchtown Middle, on the east bank, and Donaldsonville High and Lowery Middle, on the west bank, as emergency shelters.

See the rest here:

Joint effort by Ascension Parish, school district aimed at easing carpool traffic woes - The Advocate

The nations second-largest health system, Ascension, has agreed to allow the software behemoth Google access to tens of millions of patient records. The partnership, called Project Nightingale, aims to improve how information is used for patient care. Specifically, Ascension and Google are trying to build tools, including artificial intelligence and machine learning, to make health records more useful, more accessible and more searchable for doctors.

Ascension did not announce the partnership: The Wall Street Journal first reported it.

Patients and doctors have raised privacy concerns about the plan. Lack of notice to doctors and consent from patients are the primary concerns.

As a public health lawyer, I study the legal and ethical basis for using data to promote public health. Information can be used to identify health threats, understand how diseases spread and decide how to spend resources. But its more complicated than that.

The law deals with what can be done with data; this piece focuses on ethics, which asks what should be done.

Beyond Hippocrates

Big-data projects like this one should always be ethically scrutinized. However, data ethics debates are often narrowly focused on consent issues.

In fact, ethical determinations require balancing different, and sometimes competing, ethical principles. Sometimes it might be ethical to collect and use highly sensitive information without getting an individuals consent.

Public health ethics are useful to evaluate activities that affect population health. A recent report by the World Health Organization (WHO) describes public health ethics with four principles:

Public health ethics is an appropriate framework for evaluating Project Nightingale, given its massive scale. But the current health care context is relevant.

The system and its struggles

For over a decade, scholars have argued that technological solutions are needed to address three major challenges to how the health system uses information.

First, the health system struggles to integrate new knowledge into patient care. New medical evidence takes 17 years to change clinical practice, on average. The breakneck pace of science challenges doctors to keep up. And, applying modern medical knowledge requires doctors to consider more factors than is humanly possible.

Second, information is central to preventing many medical errors, the third leading cause of death in America. Communication problems, judgment errors and incorrect diagnosis or treatment decisions can have devastating consequences for patients.

Third, the system does not learn from care. For example, a doctor and patient might try several different medications before finding the right one. One medication might not help, another might cause awful side effects, and finding the best medication might take months or years. The health system does not learn from that care process. Individual providers will gain knowledge over a lifetime, but that knowledge is never aggregated or shared efficiently.

To help address these challenges, the Institute of Medicine in 2007 introduced a vision for a learning health system that would quickly learn from patient care and use that knowledge to improve future care.

The concept is simple, but learning health systems require sophisticated information technology platforms capable of extracting knowledge from the existing evidence and millions of treatment records.

The benefits of Project Nightingale

Project Nightingale appears to align with the learning health system concept. Systematically improving health care is a clear common good.

Although a learning health system requires sharing patient data, patients stand to benefit from improved health care. Reciprocal data sharing by patients for a collective benefit is a prototypical example of the common good principle in public health ethics.

Project Nightingale might also improve health equity. For example, minorities and pregnant women are underrepresented in research studies, raising concerns that some medical knowledge might not be well tailored to these patients. A learning health system would improve understanding of what treatments are effective and safe for these underrepresented populations.

For small-scale activities, respect for persons usually demands giving people an opportunity to make a free and informed decision to participate. However, for activities carried out at the scale of the whole population, it is possible to show respect for persons by engaging the public and inviting them into the decision-making process. It is not clear whether Ascension or Google involved the public or patients in Project Nightingale.

The downsides

Some patients have criticized Project Nightingale because it does not have an opt-out for patients who do not want their information shared.

However, opt-out systems raise ethical concerns, too. They permit free riders who will benefit from the knowledge gained from the participants. Second, knowledge from a learning health system could be biased if enough people opt out. If so, opting out could expose others to riskier health care.

Good governance is critical to support a common good activity that conflicts with some individual interests. Transparency and accountability are crucial to keep the parties honest and open to public scrutiny. They also empower people to demand government action against an activity that cannot be ethically justified. There is little, if any, reported evidence that Project Nightingale has sufficient transparency or accountability processes. This is likely to be the biggest ethical challenge to Project Nightingale.

Issues of consent

Some of the biggest concerns have been about consent. However, public health ethics do not always require consent. One recent WHO ethical guideline says:

Individuals have an obligation to contribute when reliable, valid, complete data sets are required and relevant protection is in place. Under these circumstances, informed consent is not ethically required.

The basic argument is that individuals have a moral obligation to contribute when there is low individual risk and high population benefit.

Currently, the public does not know enough about Project Nightingale to make definitive ethical judgments. However, public health ethics likely provides some support for what Google and Ascension are trying to do. The more critical ethical issue might turn on how Google and Ascension are doing it.

View original post here:

The tricky ethics of Google's Project Nightingale - EconoTimes

More than 1,500 community members gave input for the Milwaukee Blueprint for Peace, the city's violence prevention plan.(Photo: Provided photo)

Nearly $600,000 for the BUILD Health Challengewill come to the Sherman Park neighborhood, Ald. Khalif Rainey announced.

Part of the money for the project, called BUILD Sherman Park, will be used to implement recommendations from Milwaukee's Blueprint for Peace, a community-based violence prevention initiative created in 2017.

RELATED: Milwaukee encourages people to get behind 'blueprint for peace' goals

RELATED: Milwaukee unveils 'Blueprint for Peace,' a plan to prevent violence in the city

The funds will come, in part, from an award of $250,000 won by the City of Milwaukee Health Department's Office of Violence Prevention, Ascension SE Wisconsin Hospital at the St. Joseph campus, United Way of Greater Milwaukee & Waukesha County and the Sherman Park Community Association. Ascension Wisconsin has pledged to provide $336,000 in matching support of the grant, bringing the total funds to $586,000.

Ascension Wisconsin officials said the health system's participation is proof of how it is committed to Milwaukee's underrepresented communities.

The BUILD Health Challenge, is a national program meant to improve community health through community and health system partnerships, according to the website. The award requires hospitals to at least match the BUILD grant and will include other tools, such as coaching, support services and specialized training. The money for BUILD Sherman Park will be distributed over the next two years.

Rainey described the investment in Sherman Park as "transformative" for its residents.

Milwaukee joins over a dozenother cities who won the national challenge for the 2019 year, including Oakland, California; Houston, Texas and Washington, D.C.

There will be a kick-off event for the BUILD Sherman Park project Tuesday, Dec. 17 at 5:30 p.m. at the Sherman Phoenix, 3536 W. Fond Du Lac Ave.

Contact Talis Shelbourne at (414) 223-5261 or tshelbourn@jrn.com. Follow her on Twitter at @talisseerand Facebook at @talisseer.

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Nearly $600,000 to come to Sherman Park neighborhood for the BUILD Health Challenge and Ascension Wisconsin - Milwaukee Journal Sentinel